Pennsylvania insurance commissioner could get power to force UPMC-Highmark talks

Another bill aimed at forcing Highmark and UPMC back to the negotiating table has been introduced in Harrisburg.

This one, unveiled during a Tuesday news conference, is sponsored by state Rep. Tony DeLuca, D-Penn Hills, and would give the state Department of Insurance and its commissioner greater latitude when it comes to forcing negotiations and, if necessary, binding arbitration between two warring health care organizations.

"The ongoing debate between the University of Pittsburgh Medical Center and Highmark has left many confused and afraid of losing access to the doctors and hospitals they've come to trust," Mr. DeLuca said in a statement.

Under an existing 39-year-old law, known as Act 94, the state Insurance Department can suspend the termination of a contract between a hospital and a Blue Cross Blue Shield insurer by up to six months.

A similar bill was introduced in the previous legislative session, but it was not passed into law. This bill, HB 1964, allows the insurance commissioner to step into the fray to deal with all contract expirations and terminations between hospitals and insurers, according to a co-sponsorship memo circulated in Harrisburg.

The insurance commissioner would have the authority to extend an expiring contract by up to six months, and then impose a new, mediated contract of up to 18 months, under the proposed law.

Highmark is the region's dominant health insurer, and UPMC the region's largest health and hospital network; the current contract between the two is set to expire at the end of 2014.

If a new contract isn't signed before then, starting in 2015 many Highmark customers won't have access to the majority of UPMC hospitals and specialists at in-network prices unless they switch insurers -- which is what UPMC is hoping for.

UPMC says it doesn't want to sign a new deal with Highmark because the insurance company became a direct competitor to UPMC with its purchase of the ailing West Penn Allegheny Health System and subsequent launch of the Allegheny Health Network. UPMC also offers insurance through its UPMC Health Plan.

Also in the state House, Western Pennsylvania legislators are considering a so-called "any willing insurer" bill that would effectively require hospitals that are part of an "integrated delivery network," such as UPMC, to contract with any willing insurer.


Source Post-Gazette